Who to Believe – My Plastic Surgeon or My Dermatologist?

Q:  I am 54 years old and beginning to see signs of aging.   I asked my dermatologist for suggestions regarding products and she told me I was “too far gone” and suggested a laser procedure. I saw a plastic surgeon who told me that was nonsense and suggested a face lift instead. I want to look better but don’t know who to believe.
-Mary D.
Rancho Santa Margarita

A:  I can begin by telling you that both are correct, at least in part, and I am certain that both doctors are giving you advice based on their view points, training and expertise. The problem is that most dermatologists do laser resurfacing and not surgical procedures – they tend to recommend procedures they know how to do, regardless of what is best for the patient. And likewise, many surgeons do not do resurfacing procedures and may suggest a surgical procedure without considering the resurfacing option.

Without being able to see you in person, I will have to answer this question in the most general terms. I will begin by telling you a few words about aging and what we can do about it. Two events happen simultaneously as we age. Surface changes occur from excessive sun damage. You can use sun blocks, hats and sun glasses to minimize sun damage as you get older.  A laser treatment will remove these superficial signs of aging, but will not affect the dropping and skin laxity, particularly in the jowl and neck regions, that also occur with time. These latter changes are the result of heredity and will not be altered by sun blocks or helped with a resurfacing procedure. In order to alter neck and jowl sagging, plastic surgeons pick these layers back up and tighten them as part of any traditional or midface lift procedure. Frequently, brows will be elevated back to where they once were, or baggy eyelids will be addressed at the same operation so as to restore a sense of balance to the final result – for example, very baggy eyelids would detract from an otherwise well done face lift which gave a patient a youthful neck. But such surgery will not alter sun damage or the quality of your skin.

Another very important factor is a patient’s expectations – these have to be met! Some patients want nothing but a total improvement, others are willing to settle for less improvement because they are not bothered by certain features or because they are trying to save money.

Your best bet is to find an aesthetic surgeon well versed in both the traditional surgical procedures as well as the various resurfacing procedures (chemical peels, laser resurfacing and dermabrasion) so that you can be presented with all the options and then you can decide which is the best option for you.

The best way to illustrate the various options is with a few before and after photographs of actual patients treated by Dr. Bunkis:

First we have this 58 year old female with slight facial laxity and marked sun damage.  She would still have looked quite weathered had we performed just a traditional lift.  Likewise, a laser resurfacing would have improved her facial texture but she would still have had a lax neck and jowls.  I think you will all agree that she benefited most from a facelift and full face resurfacing, all performed at the same sitting.

Our second patient is a 44 year old former ski instructor, with extensive sun damage but not enough skin laxity (i.e. does not have significant neck laxity or jowls) to warrant any type of surgical lift.   She was treated solely with a minimally invasive, skin resurfacing procedure, without any surgical incisions, to remove her fine lines and brows spots.

(Actual patients of Dr. Bunkis, your results may vary)